Distension of the neck veins due to increased blood volume and increased preload.

Moist skin (as compensation to increase the excretion of water through perspiration).

Acute weight gain due to an increase in the total volume of body fluids because of overloading the circulation (which is the best indicator to demonstrate the advantages of extracellular fluid volume).

Edema (increased mean arterial will cause an increase in capillary hydrostatic pressure, causing fluid displacement from the plasma into the interstitial space).

S3 gallop sound (abnormal heart sounds due to the rapid charging and volume overload in the ventricle during diastole).

Bowel training is training the intestine to reestablish normal bowel movements in people who suffer from constipation, diarrhea, fecal incontinence. Bowel training (defecation training) is a training program that is conducted on clients who have bowel incontinence or unable to maintain control of defecation. In simple language bowel training could be interpreted as helping the client to train defecation. The program is carried out on clients who have problems of irregular stool elimination.

On the client experiencing chronic constipation, frequent obstipation / fecal incontinence, bowel training programs can help overcome them. The program is based on factors within the control of the client and is designed to help clients get back to normal defecation. The program is associated with fluid and food intake, exercise and defecation habits.

Before starting the program, the client must understand and be directly involved. In broad outline of this program are as follows:

Determine the client defecation habits and the factors that help and hinder the normal defecation.

Design a plan with clients that include:

Fluid intake around 2500 - 3000 cc / day.

Increased high-fiber diet.

Intake of warm water, especially before the time of defecation.

Increased activity / exercise.

Keep the following things in daily routine for 2-3 weeks: Give Laxatives 30 minutes before the time of defecation clients to stimulate defecation.

Indication

Bowel training is done on the client with bowel incontinence (unable to control the normal stool output), helping clients get defecation normal and routine.

Definition of Acute Respiratory Distress Syndrome According to Experts

ARDS is a disease caused by extensive damage to the alveoli and / or pulmonary capillary membrane. ARDS always happens after a major disruption in the system of pulmonary, cardiovascular, or body widely. (Ellizabeth J. Corwin, 1997)

ARDS is a medical emergency triggered by various acute processes that directly or indirectly associated with lung damage. (Aryanto Suwondo, 2006).

ARDS occurs when the exchange of oxygen for carbon dioxide in the lungs are not able to maintain the rate of oxygen consumption and carbon dioxide formation in the cells of the body. Thereby causing oxygen tension less than 50 mmHg (hypoxemia) and an increase in carbon dioxide pressure greater than 45 mmHg (hypercapnia). (Brunner and Sudarth, 2001)

ARDS is a sudden respiratory failure events that occur in adult clients with no previous underlying pulmonary disorder. It is difficult to make a precise definition, because the pathogenesis is unclear and there are many predisposing factors such as shock because of haemorrhage, sepsis, involuntary / trauma to the lungs or other body parts, acute pancreatitis, aspiration of gastric fluid, intoxication heroin, or methadone. (Arif Muttaqin, 2009).

Diabetic ketoacidosis caused by lack of insulin or insufficient amount of insulin that is real, this situation led to disturbances in the metabolism of carbohydrates, proteins and fats. There are three important kliniks picture in diabetic ketoacidosis is dehydration, acidosis and electrolyte loss.

If the amount of insulin is reduced, the amount of glucose that enters the cell will be reduced as well. Besides, the production of glucose by the liver becomes unmanageable. Both of these factors will result in hyperglycemia. In an effort to eliminate the excess glucose from the body, the kidneys excrete glucose together water and electrolytes (such as sodium and potassium). Osmotic diuresis which is characterized by excessive urination (polyuria) is the cause dehydration and electrolyte loss. Patients with severe ketoacidosis can lose approximately 6.5 liters of water and up to 400 to 500 mEq of sodium, potassium and chloride during a period of 24 hours.

Another result of insulin deficiency is the breakdown of fat (lipolysis) into free fatty acids and glycerol. Free fatty acids are converted into ketones by the liver. In diabetic ketoacidosis occurs excessive production of ketone bodies as a result of a lack of insulin which normally would prevent the situation. Ketones are acidic, and when accumulated in the blood circulation, ketones will cause metabolic acidosis (Brunner and suddarth, 2002).